MS ankle foot special tests/ knee lab

Question 0

PROM motions at each joint...
 hindfoot (2 joints/ 2 movements)
 midfoot 
 forefoot (2 movements at 1 joint)

then next progression

Answer 0

hindfoot:

talocrual: DF/PF
subtalar: inversion/eversion

midfoot:
ab/aD of midtarsals

forefoot:
flex/ext
ab/ad at phalangeal

progress to resisted isometric

Question 1

cyriaxs ankle/ foot
WB & non- WB (8)
what to do if it elicits pain or no pain

Answer 1

active movements in both WB and non:
in WB have pt walk on heels and toes
 PF/DF
 pro/sup
 toe flex/extend, aB/ad

if no pain => PROM and test for end feel
all end feels should be tissue stretch

Question 2

resisted motion (4 sets)

Answer 2

in resting position:
 knee flex (to check gastroc and soleus)
 PF & DF w/ hip/ knee at 45/90
 sup/pro
 toe ext/flex

Question 3

muscles tested for toe flexion (8)

Answer 3

1. flexor digitorum longus (2) brevis
2. flexor hallucis longus (4) brevis
3. flexor digiti minimi brevis
4. dorsal (7) palmar interossei
5. lumbricals

Question 4

muscles tested during toe extension (4)

Answer 4

1. extensor digitorum longus (2) brevis
2. extensor hallucis longus
3. lumbricals at IP joints

Question 5

muscles tested for aBduction of toes (3)

Answer 5

1. abductor hallucis
2. abductor digiti minimi
3. dorsal interossei

Question 6

muscles tested for toe aDduction (2)

Answer 6

1. adductor hallucis

2. plantar interossi

Question 7

ankle ROM necessary for
descending stairs
walking

Answer 7

descending stairs: full DF = 20 degrees

walking:
DF 10 degrees
PF 20-25 def

Question 8

2 tests to establish subtalar neutral
normal deviation
what it means if deviated

Answer 8

1. palpation method- pt prone, hold talus and swing calc until no “bulge” on either side
2. pt prone, make marks on…
   1cm distal to calceaneal insertion (in middle)
   middle of tib 1/3 down
   use goniometer to measure

if inverted = hindfoot varus
if everted = hindfoot valgus

normal is 2-8 degrees

Question 9

testing for position of talus in WB

(-) finding

Answer 9

pt standing relaxed, hold talus with thumb and index finger and have pt rotate trunk med/ lateral

negative= talus remains neutral = no buldge

Question 10

“too many toes”
what you do
normal finding

what an abnormal finding can mean (3)

Answer 10

pt stands relaxed and view from behind how many toes are visible
should see 2-2.5 toes

“too many toes” can be from:
forefoot abduction
heel is in valgus
tib laterally rotated

Question 11

tibial torsion
normal angle
if >
if <

Answer 11

normal angle of tibial torsion = 12-18 deg

if >18 = too much ER
if <12 = too much IR

Question 12

ankle anterior drawer sign
which ligaments are u testing (2)
3 positions for test

Answer 12

testing anterior talofibular ligament
anterior talocalcaneal ligament

3 positions:

1. supine: draw talus forward (stabilize tib/fib)
2. hip/knee/ ankle flexion: push leg back
3. prone: stabilize talus and pull tib/fib towards you

Question 13

leg length test to determine where insufficiency is coming from

Answer 13

in standing, observe relationships btwn
ASIS -> ASIS
PSIS -> PSIS
ASIS -> PSIS

reposition pt with talar neutral

if no change, insufficiency is from pelvis or SI

Question 14

thompson test
what we are testing
how we test
(+) finding

Answer 14

testing for integrity of Achilles’ tendon

pt prone and relaxed, squeeze gastroc. should elicit PF…

(+) sign is no response, but if tear is not significant, will still see some movement

Question 15

neurological tests for ankle foot:
2 dermatomal
abnormal reflexes

Answer 15

L4-L5 test- posterior tib
S1-S2 achilles

babinski- abnormal sign is DF great toe, fanning digits

Question 16

toe deformities
 claw toe
 hammer toe
 mallet toe
 morton toe

Answer 16

claw toe- hyperE MTP, flex DIP & PIP

hammer toe- hyper E MTP, flex PIP

mallet toe- flex DIP

morton toe- 2nd toe longest (may hypertrophy b/c extra stress)

Question 17

hallux valgus
def
normal (and non) values 3

Answer 17

increase in MTP of big toe so much that may start to overlap with 2-3 toe (or go under them)

8-20 degrees = normal
20-30 degrees = congrous
>30 degrees = pathological

Question 18

pes planus
test

pes cavus
problems it can cause

Answer 18

pes planus test = feiss line
draw a line from med mall => 1st MT
go to stand, if navicular drops below = pes planus

pes cavus= increased WB on heel & MTs => callus

Question 19

diff dx arterial ulcer vs. venous ulcer

Answer 19

aterial ulcer feels better when leg is down because more blood circulating

venous ulcer feels better when legs are elevated b/c relieves pressure

Question 20

some knee pain scales (3)

Answer 20

1. anterior knee pain scale
2. LE functional scale
3. global rating of change form**
   really good if pt says nothing is getting better but you see improvement => objective measure

Question 21

amt of knee flexion needed for...
 swing phase of gait
 up stairs
 down stairs
 sit
 tie shoes

Answer 21

swing phase of gait = 65 deg
        up stairs =           85 deg
        down stairs =      90 deg
          sit =                   95 
        tie shoes =          105

Question 22

which direction to I push/ pull if my pt is limited in flexion?
3 optional positions

Answer 22

push tibia posterior b/c concave on convex
  can do in sitting
    on table (anterior drawer)
    legs off table with distraction
  supine
  prone with knee bent

Question 23

which direction to I push/ pull if my pt is limited in extension?

specific treatment for terminal ext

Answer 23

pull anterior because concave tib moving on convex

terminal ext- do dorsal glide of femur
have pt supine, knee as close to end range ext as possible
stabilize tib and give posterior force on femur

Question 24

lateral glide of tib on femur
position
indication

medial glide of tib on femur
positon
indication

Answer 24

lateral glide of tib on femur => IR & varus
side ly, use both hands to carefully glide tib

medial glide of tib on femur => ER & valgus
side ly with leg on step stool and medialls glide

these are important for screw home mechanism**

Question 25

what creates the base of the femoral triangle?

what creates the floor?

Answer 25

inguinal lig = base

pectinus = floor